Tomblin expands Medicaid

Gov. Earl Ray Tomblin announces the expansion of Medicaid at St. Francis Hospital on Thursday.

Chris Dorst
Sen. Jay Rockefeller, D-W.Va., Tom Jones of West Virginia United Healthcare System and Rev. Randy Flanagan of Christ United Methodist Church applaud during Tomblin's announcement of Medicaid expansion.

Chris Dorst
Tomblin announces that West Virginia will expand Medicaid to more state residents on the front lawn of St. Francis Hospital Thursday.

CHARLESTON, W.Va. -- Calling it the state's best option, Gov. Earl Ray Tomblin announced Thursday that the state will expand its Medicaid program under the federal Affordable Care Act.

"Although we may not agree with every provision of the ACA, I must make a decision for West Virginia based on the circumstances presented to me," Tomblin said during a press conference Thursday. "At the end of the day we have weighed the options and believe expanding Medicaid is the best choice for West Virginia."

Medicaid eligibility requirements will be expanded to include state residents who make up to 138 percent of the federal poverty level.

Under the expansion, Medicaid coverage would be extended to include a family of four making up to $32,500, or a single person making up to $15,856.

Under the ACA, the federal government will pay the total costs of expansion for the first three years. After that the federal government's share would gradually drop to 90 percent.

State officials say if the federal government goes back on the promise of funding, the state "may be forced to discontinue providing health-care benefits to the expansion population."

Speaking at a press conference Thursday, Sen. Jay Rockefeller, D-W.Va., said he feels "absolute, sheer happiness" about the expansion of Medicaid.

He praised the time and diligence the governor took to reach that decision.

Rockefeller said Tomblin is right to question the federal government's commitment to funding.

"Why would a governor necessarily believe what the Congress says?" Rockefeller said. "And so he's quite proper to take the caution and to review again, but we're not going to fold on that one.

"This is a commitment to the American public which makes so much financial sense," he said.

Tomblin's office had been waiting on the results of an actuarial study about the state's cost of expansion.

According to that study, expanding Medicaid will provide insurance coverage to about 91,500 state residents.

"Behind all the numbers discussed today are thousands of West Virginians who will benefit greatly from Gov. Tomblin's action. It is the waitress who serves us lunch today, the man working for a small roofing company, the women working at a child care center, the aide at a nursing home," said Perry Bryant, head of West Virginians for Affordable Health Care.

"These are hardworking West Virginians who struggle without health care. Now they will get the coverage they deserve thanks to the leadership of Governor Tomblin," Bryant said in an emailed statement to the Gazette.

The state's costs for expansion will be about $375.5 million from fiscal year 2014 through fiscal year 2023, and will mean an additional $5.2 billion in federal funding for the same time period, according to the actuarial study.

To help with the state's costs for Medicaid, Medicaid recipients will be assessed co-payments according to their income.

The state can make up the money for expanding Medicaid in several ways, officials say.

For instance, the state spends $12 to $15 million each year on uncompensated care, which is the amount that hospitals pay to treat patients who don't pay for care. With Medicaid expansion, the amount the state spends will decrease, officials say. A recent audit of the state's Department of Health and Human Resources identified more than $50 million in savings that can be used for the state's share in Medicaid, officials say.

New Medicaid recipients also will be required to use a managed care organization. These companies are similar to health maintenance organizations (HMOs), and agree to provide most Medicaid benefits to people in exchange for a monthly fee from the state, according to Medicaid.gov.

Enrollment in the expanding Medicaid program will begin Oct. 1 and coverage will begin Jan. 1, 2014.